Oral glucose-lowering medications are associated with excess risk of heart failure ( HF ). Given the absence of comparative data among drug classes, researchers have performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between heart failure risk and use of sulphonylureas, dipeptidyl peptidase 4 inhibitors [ DPP-4i ], and glitazones.
Researchers have extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with Metformin during an accrual time of 2 years.
The endpoint was hospitalization for heart failure ( HHF ) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years.
A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on Metformin as combination therapy.
Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events.
During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of hospitalization for heart failure compared with sulphonylureas [ hazard ratio, HR=0.78; 95% confidence interval ( CI ) 0.62-0.97; P = 0.026 ].
After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of hospitalization for heart failure ( HR=0.70; 95% CI 0.52-0.94; P = 0.018 ).
IN conclusion, in a very large observational study, the use of DPP-4i was associated with a reduced risk of hospitalization for heart failure when compared with sulphonylureas. ( Xagena )
Fadini GP et al, Eur Heart J 2015; Epub ahead of print